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General NPI Number Information
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NPI Number | 1063738086
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Entity Type | Individual
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Provider Name | DESIREE K CUNNINGHAM-LOGGINS LISW
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Gender | Female
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 917 W 4TH ST
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City | WATERLOO
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State | IA
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Zip | 50702-2801
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Country | US
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Telephone | 319-234-1572
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Fax | 319-234-1576
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Provider Business Mailing Address
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Address Line | 100 E EUCLID AVE SUITE 143
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City | DES MOINES
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State | IA
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Zip | 50313-4511
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Country | US
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Telephone | 515-256-8001
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Fax | 515-256-8082
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 06390
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License Number State | IA
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